Hi, I have a question about unequal pupils.
background: 28 yr old female; overall healthy; hx of left sided tension headaches (tight neck/occipital region) for about 10 years. negative MRI/MRA/MRV a few years ago which showed incidental finding of Jugular Megabulb (left side). These tension headaches fluctuate with my menstrual cycle, I notice them more mid month and right before menstruation. I now carry around a 30 lb toddler also, which puts an extra strain on my left shoulder and neck.
Here is my ?: I have ZERO vision issues (no blindness, double vision, color loss, etc) but have noticed some serious eye strain (bilateral, but mostly left) after using the computer for several hours a day thanks to my new job. This has in turn, caused more tension headaches following long hours computer use as well as a touch of photophobia when under fluorescent lights or the sun's reflection off the bright snow. A few weeks ago, after feeling some left eye strain (tightness/pulling sensation w/ movement) I looked in the mirror and noticed my left pupil was dilated more so than my right (this was in dim to darker light) Both pupils react equally and timely to light...so there is no delay or other issues such as vision changes. Throughout the week I noticed my pupils being different sizes, but also switching eyes...sometimes the right pupil is briefly larger and much of the time they are equal size. I was just wondering what causes the pupils to vary in size throughout the day and switch from eye to eye? Can this be from eyestrain? Or the headaches? In the morning upon waking, my pupils are ALWAYS totally equal but as the day goes on (and headache or eyestrain sets in) they can vary a bit in size most days (over the last couple weeks)
Again, negative MRI/MRV/MRA 2 years ago and no other current symptoms other than the unequal pupils, tension headaches and photophobia (which I was assuming was from computer eyestrain?)
any input would be greatly appreciated!
thanks in advance!

Computer use and eye strain will not cause unequal pupils. Use a non-flash, non-red eye reducing digital camera to photograph the different size. Have someone take your picture while you look across the room or out the window. (don't focus at near). Migraines can cause unequal pupils. Perhaps 10% of the population have small differences in the size of their pupils (but they do not alternate).

See an Eye MD. If possible a neuro-ophthalmologist. Find one at www.aao.org Have the eye MD check you before the staff put ANY drops in your eye.

thank you for your timely response. My insurance will unfortunately only initially cover an optomitrist who then can refer me (if necessary) elsewhere. Until my appt (next week) I have just a few more questions. Like I said previously, I have daily tension headaches/migraines beginning in neck and ending unilateral/bilaterally (depending on the day) brow region. I find my pupil size seems to correlate with these headache patterns. At their most drastic size difference, they are only ever 1mm or less unequal and both respond promptly/equally to light. They seem to be the same size difference in both light/dark (of course, either constricted in light or dilated in dark) but remain the same difference or just SLIGHTLY different <0.5mm. However, like I said previously, they CAN alter sides. I found several articles stating this is a sign of physiological anisocoria (see-saw/alternating anisocoria)
Is this accurate? Does my specific situation sound physiological to you? One other question I have is, although I have never noticed the pupil difference previously (when I was younger) is it possible to "develop" physiological/simple anisocoria later in life?

yes and thats what I ended up doing, going straight to an opthamologist under medical insurance. She said physiological anisocoria does indeeed alternate (and when it does its called benign alternating anisocoria) and from hour to hour can vary in the degree of size difference (although they usually stay under 1mm difference). As long as they are equally reactive to light/dark and stay the same difference in light/dark then they are considered benign. I am following up w/ a neuro-opth to confirm this but she said she'd bet her medical degree on this diagnosis. We'll see!

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